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Diagnostic Imaging in Alberta

Diagnostic Imaging in Alberta. Dr Bill Anderson, Edmonton Zone Clinical Director Mauro Chies, Vice President Diagnostic Imaging Services. Diagnostic Imaging Structure.

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Diagnostic Imaging in Alberta

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  1. Diagnostic Imaging in Alberta Dr Bill Anderson, Edmonton Zone Clinical Director Mauro Chies, Vice President Diagnostic Imaging Services

  2. Diagnostic Imaging Structure • Divided into Local Operations. Divided into three zones with a “dyad” leadership model consisting of a Clinical Director and an Executive Director

  3. Clinical Support Services Diagnostic Imaging Services Vice President Diagnostic Imaging Services Mauro Chies (1.0 FTE) Administrative Assistant Shenaz Jiwa (1.0 FTE) Manager Projects Amin Allibhoy (1.0 FTE) Executive Director Suburban/Rural Peter Froese (1.0 FTE) Executive Director Calgary & Area Carla McAuley-Gilmore (1.0 FTE) Executive Director Edmonton & Area Lorena Cabral (1.0 FTE) Director Quality, Safety and Education & Alberta Radiation Protection Agency Marlene Stodgell-O’Grady (1.0 FTE) Director Equipment, & Informatics Brian Van Skiver (1.0 FTE) Manager PLC Mark MacMillan (1.0 FTE) Director UAH/Stollery/ Mazankowski Fred Kozin (1.0 FTE) Zone Director North Ted Nessman (1.0 FTE) Manager Equipment and Informatics Jack Berry (1.0 FTE) Quality, Accreditation & Safety (function) Manager RGH Sandra Hovey (1.0 FTE) Manager Equipment and Informatics Brian de Haan (1.0 FTE) Zone Director Central Kate Luchenski (1.0 FTE) Director RAH, GRH, AHE, Eastwood Barry Bowtell (1.0 FTE) Manager ACH David Schmidt (1.0 FTE) Education, Workforce Planning and Staff Development (function) Manager Equipment and Informatics Lina Maidens (1.0 FTE) Manager FMC Mike Carson (1.0 FTE) Zone Managers South Donna Castelli (1.0 FTE) Pat Laevens (1.0 FTE) Director Community/ Urban/Rural Joe Lopes (1.0 FTE) Manager Rural DI Colleen Hansen (1.0 FTE) Manager Performance Management Stephanie Watson (1.0 FTE) Director Cancer Imaging Serv. Don St Hilaire (1.0 FTE) Manager Community DI Deb Lausen (1.0 FTE) Local Operations Provincial Support Team

  4. Diagnostic Imaging Governance • Diagnostic Imaging Provincial Executive Team (DIPET) is the strategy and decision body for DI in the Province reporting up to Andrew Will, EVP, Clinical Support Services. • Modality Liaison groups (ie MRI, CT etc) make up the content experts and knowledge transfer groups consisting of radiologists, technologists and managers reporting up to DIPET.

  5. Diagnostic Imaging Governance • Strategic direction • Policy approval • Budget allocation • Provincial service coordination Diagnostic Imaging Provincial Executive Team Liaison / Content Experts QUALITY, SAFETY & EDUCATION SUBURBAN / RURAL CALGARY EDMONTON EQUIPMENT & INFORMATICS CT MRI DI Leadership Team DI Leadership Team DI Leadership Team DI Quality & Safety Team DI Equipment Leadership Team U/S DI Operational Team DI Operational Team DI Operational Team • Service Contracts • Informatics • Policies • Metrics • Quality • Safety • Policies • Education Zone Management Gen Rad IR PEDS • Standards on: • Equipment • Policies • Procedures/Process • Technical Experts • Equipment selection • Operation Accountability • Local Budget • Recommendations Nuc Med Informatics Radiation Safety

  6. DI Provincial Function • Diagnostic Support and consultation for Ultrasound, Gen Rad, Nuclear Medicine, CT, MRI, Interventional Radiology and Cardiac Catheterization for all AHS facilities (2.7 million exams annually) • Approx 130 sites • Community support through Community Providers • Interventional Therapies and treatment (O.R. style services)

  7. Diagnostic Imaging Model in Alberta • Approximately a 50-50 activity split between community and hospital activity. • Community imaging providers operate independently and are funded through the Schedule of Medical benefits (SOMB)

  8. Diagnostic Imaging Model in Alberta – cont’d • CT and MRI are only funded through AHS global operations. SOMB does not cover MRI and CT in the community. • Community providers can and do provide these services through Private Pay, WCB, industry and military.

  9. Diagnostic Imaging at a glance • 22 MRIs in the province. (includes 1 for cancer imaging, 1 mobile, 1 intra-operative and a 3 Tesla for clinical and research)

  10. MRI 90 day Access Working Group • Established in 2002/03 • Consisted of Radiologists, managers and representatives of physician practice and Alberta Health and Wellness • Developed Prioritization guidelines to be utilized at target wait times and appropriateness. • Agreed to and approved by local Medical Advisory Committees.

  11. MRI Prioritization Guidelines • MRI Outpatient Prioritization categories are as follows: • Priority One (less than 7 days) • Priority Two (less than 30 days) • Priority Three (less than 90 days) • Priority Four (scheduled exam follow-up as clinically necessary)

  12. MRI Utilization in Alberta

  13. Future State (? Date Project Proposal) • Physician requests MRI • EMR feeds specific information into a CPOE with CDS tools (CAR Appropriateness Criteria) • a) More appropriate exam or consultation is suggested, or request is denied as inappropriate, Physician may over ride • b) Through web based schedule exam is booked and appointment confirmed with Patient at the time (option to request alternate time)

  14. Spine Exams AHS Edmonton

  15. L-Spine Plain X-rays in Community • Clinic volume 50% of imaging • Typically higher % of plain images • Top 10 “requestors” • 6 Chiro, 1 Ortho, 3 FP • Top 5 • Chiro • (45% of L-spine X-rays, often include pelvis, T and C-spine as per routine)

  16. Low Back Pain Guidelines Process • TOP (?) – ensure adequate stakeholder input (no DI, Ortho, Neuro) was an oversight for this guideline • “aimed more at physical activity/pain management” • Patient driven issues (FP, want vs. need, issue of “value of knowledge” needs study ? IHE??)

  17. Low Back Pain Guidelines Process • Issues: Red Flags and “consider referral” • Volumes (fear of increased volumes) • Ortho and Neurosurgery want MRI pre-consult what does the FP do?? • Resolution ??? Now at KT? • (?) Clinical Network (including imaging expertise) with AMA review and perhaps revise or change referral process (currently has a Low Back Pain subcommittee)

  18. Unintended Consequences • Ottawa Ankle Rules • 13% increase volume, 3% increase ER visits • L-Spine X-rays (Red Flags) • JAMA (Suarez-Almazor et.al. 1997) • (13% ordered, 44% with guidelines) 238% increase • CT Head, Peds Trauma (CMAJ, Stiell et al, 2010) • KT did not reduce rates of Head CT (65 to 75%, p=0.16)

  19. Solution • Complex • Knowledge Transfer is certainly critical • Tool must be appropriate within Alberta and patient – physician (clinician) relationship • One area but a more robust solution is necessary • CPOE with CDS • Patient Portal with KT tools (?)

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